Maternal deaths attributed to HELLP syndrome

Hyderabad: Maternal deaths in government hospitals are suspected to be due to the HELLP Syndrome, so named after the three main features of the syndrome: Hemolysis, Elevated Liver enzymes and Low Platelet count. Director of health and medical education, Dr M Ramani, says doctors are trying to evaluate the different causes of deaths and an audit team under Dr Neelima Singh is looking into all these aspects.

“The one thing which we have found in Nayapul Maternity Hospital is that patients are coming at the last minute and there has not been any follow-up done before. No history of check-up in any hospital. A mother who recently died at the hospital came with a blood count of 2.5. Due to this reason we are developing intensivists who will be in maternal intensive care units and will only look after these complicated cases,” Dr Ramani says.

The audit team is also looking into cases of HELLP. In the 11 maternal deaths there were complications like profuse bleeding, acute hepatitis, failure of contraction of uterus muscles, infections, sepsis and shock. Most of the mothers who died were between the ages of 19 and 30 years. In most of the cases, it was the delivery of the second or third child and the complications developed after childbirth.

Of the six lakh deliveries that take place in TS every year, it is estimated that 50,000 women suffer from this syndrome. The onset of this syndrome is sudden and hence post-operative monitoring is important to identify it and act on it. Dr R. Srivedi, a gynaecologist at Nayapul says, “We are looking at HELLP in those critical cases where we have not been able to identify the exact cause of death. Our aim is to find out why the women went into cerebral shock and what are the early signs that we must look out for.”

All the three government maternity hospitals handle more than 50 deliveries per day. Ten to 12 of these are C-sections and require adequately trained paramedical staff and a special emergency team in case of any complications. The three maternity hospitals do not have such emergency facilities and so if complications do occur, the patient has to be moved to Osmania General Hospital. HELLP is a life-threatening complication which usually occurs during the last stage of pregnancy or sometimes after childbirth.

In this syndrome there is high blood pressure and it keeps on increasing. This affects the other organs of the body and also leads to cerebral stroke. It is often mistaken for acute hepatitis, gall bladder disease and other gastric conditions. The syndrome requires the care of an intensivist, a doctor who deals with critical care and complex cases, as such patients cannot be handled by a gynaecologist.
The post-operative care requires transfusion of blood and blood products to stabilise the patient. The liver also requires to be monitored as any ruptures in the same have to be controlled.